Nutrition Transition in Papua New Guinea (PNG): An Assessment of the Nutrition Transition for Three Diverse Populations, Including the Contributing Factors, Food Insecurity, and Health Risks

Abstract

BackgroundNutrition transition refers to changes in diets and physical activity patterns as countries undergo economic growth, urbanisation with increased reliance on the global food supply. It is associated with a rapid increase in obesity and diet-related non-communicable diseases (NCDs). Although NCDs are increasing worldwide, the rise in low- and middle-income countries (LMICs) has become more rapid, with greater implications because of the double burden of diseases with the concurrent burden of infectious diseases. In high income or developed countries this phenomenon is well established. Unfortunately, information from LIMCs are more limited and are intertwined with food insecurity issues. In Papua New Guinea (PNG) studies that explore such important issues are scarce especially at this crucial period when the country is experiencing rapid transformation due to economic development. This research explores the nutrition transition in PNG by investigating dietary and physical activity patterns to provide an insight into characteristics of changes and their effects on health outcomes.Processes and Methods of Data CollectionThere are two main components to this research. The first is development and validation of data collection methods and confirmation of survey processes. The second component is a population survey of adults that explored the diets, physical activity (PA) and food insecurity across sites selected to provide a sample of populations (Highland and Coastal, rural and peri-urban) affected to a varying extent by major projects and economic development.The first component was undertaken in four study sites (Asaro, Karkar, Hides/Komo and Hiri) to document dietary patterns and practices, and develop the dietary data collection methods and interview aids. This included participatory and in-depth interviews to establish a rich base of qualitative dietary data on diet. The 24-hour recall method was trialled for quantitative dietary data collection and protocols developed. This component also included a tracing study of adult participants in the Asaro and Hiri sites was undertaken to establish common activities to construct the PNG-Physical Activity Questionnaire (PNG-PAQ). This was validated in a separate sample against an accelerometer. The food insecurity questions were based on the eight-statement food insecurity measure for Maori and Pacific Islanders in New Zealand and tested across the four sites.The second component was undertaken in a representative sample of adults from Asaro, Karkar, and Hiri. The 24-hour recall method, PNG-PAQ and food insecurity questions were asked through interview. Demographic and socio-economic data were available through the routine demographic surveillance undertaken for these sites. ResultsThe qualitative diet study showed that rural populations continue traditional diets that consist largely of garden foods, while contribution of store-bought foods was higher in the peri-urban site. In the rural Asaro and peri-urban Hiri, inclusion of vegetable oil was common and among Hiri participants snacking of store-bought foods was becoming common. The 24-hour recall method was shown to be an appropriate method with survey aids created for use in the study, which enabled observations of diet variation across populations incorporated in the study.The PA tracing study resulted in 44 activity classifications which were categorised under five domains (cash earning/schooling, subsistence farming/cash cropping, home chores, transport, and leisure) to develop the 26-question PNG-PAQ. The validation study showed an acceptable level of validity in measuring moderate to vigorous PA (MVPA) while the soundness of measuring sedentary activities was weaker.Intakes of total energy, protein, fat, carbohydrate, iron and vitamin A were assessed to reflect diet quality. All sites reported inadequate nutrient intakes, apart from iron, in comparison with Estimated Average Requirements. This was consistent with the low levels of obesity observed.Physical activity results showed a subsistence-oriented pattern in the rural sites, with addition of household chores associated with permanent housing and introduction of cash cropping activities. In the peri-urban population paid employment was included along with subsistence activities. Across the sites some modern labour-saving tools have been incorporated, particularly with the use of powered boats and vehicles to travel long distances, though these are more common in the peri-urban population.Analyses showed site differences in diet and PA that were not explained by wealth and education, key indicators of socio-economic development. Food insecurity is a reality at the household level, with the main risks related to failure in the gardens shifting towards income-based food insecurity in households more dependent on store-bought foods.ConclusionThe nutrition transition appears to be in early stages in much of PNG with gradual change in rural areas, but more evident in peri-urban and urban areas. The changes vary across sites and overall the rate of changes is slower compared to patterns reported in the neighbouring Pacific Island Countries and Territories. Understanding these patterns of change assists with development of appropriate and effective prevention measures for both NCDs and infectious diseases.